개원 가정의를 상용 치료원으로 이용하는 고혈압 환자의 건강행태와 일차의료 서비스 질
Association between Primary Care Quality and Health Behaviors in Patients with Essential Hypertension Who Visit a Family Physician as a Usual Source of Care
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초록
연구배경: 일차의료에서 고혈압 환자의 관리가 많이 이루어지나 그 관리 수준은 만족스럽지 못하다. 개원 가정의를 상용치료원으로 이용하는 고혈압 환자들의 건강 행태와 일차의료서비스 질을 살펴봄으로써 건강증진 활동의 향상 방안을 찾아보고자 하였다. 방법: 한국 일차의료 평가도구(Korean Primary Care Assessment Tool, KPCAT) 개발과 타당도검증을 위한 조사(2007년4-6월) 기간 동안, 가정의학과 의원(총 9곳: 서울 3곳, 경기 3곳, 경주-포항 3곳)에서 수집된 602명의 자료 중, 고혈압 환자(134명) 자료를 분석하였다. 참가 자격은 해당 의료기관을 상용 치료원(처음 방문하고 6개월이 경과하고 6회 이상 방문 경험이 있는 의료 제공자)으로 이용하는 환자 또는 그 보호자에한정되었다. 환자의 연령, 성, 소득, 교육연한, 첫 방문 후 경과기간 등 인구사회학적 정보와, 흡연력, 음주력, 운동습관, 비만도, 그리고 KPCAT 5영역 평가점수를 분석하였다. 통계처리는SAS ver. 8.11 프로그램을 이용하여 T검정, 카이제곱 검정, 다중로지스틱 회귀분석을 이용하였다. 결과: 개원 가정의를 상용 치료원으로 이용하는 고혈압환자들은 KPCAT 5영역 중에서, 전인적 돌봄을 가장 높게(71.7/100), 그리고 조정기능을 가장 낮게(49.7/100) 평가하였다. 일차의료 서비스 질을 평균(69.2/100) 이상으로 높게 평가한 환자들은 환자-의사 관계의 지속기간이 유의하게 길었다(P=0.035). 인구사회학적 변수들을 통제한 상태에서 일차의료 서비스 질을 높게 평가한 환자들은 낮게 평가한 환자들에비하여 체질량 지수가 정상(BMI<25 kg/m2)일 경우의 교차비가 2.53배(P=0.02), 건강한 음주 습관을 가질 경우의 교차비는4.32배(P=0.02)로 나타나 건강행태가 양호한 것으로 나타났다. 결론: 고혈압 환자의 일차의료 서비스 질이 건강행태와 연관성이 있다는 사실은, 제도 개혁을 통한 일차의료 서비스 질 향상이 고혈압 환자의 혈압관리에 기여할 수 있음을 시사한다.
Abstract
Background: Management of hypertension has been performed mainly in primary care institutions, but hypertension control in population is still unsatisfactory. This study was aimed at finding a strategy to improve health promotion activities in patients with hypertension by exploring the association between health behaviors and quality of primary care. Methods: April to June in 2007, a questionnaire survey of the patients who has a family physician as a usual source of care was conducted for the development of the Korean Primary Care Assessment Tool (KPCAT). In this study, a usual source of care was defined as a physician of the persons who had visited their primary care clinic on six or more occasions over a period of more than 6 months. Of the data collected from 9 private clinics (3 in Seoul and 6 at small cities), cases of the patients who marked on having hypertension were selected. The associations between levels of quality of primary care and socio-demographic characteristics or health behaviors were analysed by Student t-test and chi-square test. Controlling socio-demographic variables, the association between quality of primary care and health behaviors was examined by multiple logistic regression analysis. Results: Among the patients (n = 602) of 9 private clinics who has a family physician as a usual source of care, those who marked on having hypertension were 134. Among 5 domains of the KPCAT, the highest domain in score was personalized care (71.7/100), and the lowest domain in score was coordination function (49.7/100). In patients who gave total average (69.2/100) or more in total primary care score, after adjustment with age, sex, income, education, and duration, odds ratio to have a normal BMI (<25 kg/m2) was 2.53 (P = 0.02), and odds ratio to have a habit drinking an adequate amount of alcohol was 4.32 (P = 0.02). Conclusion: The fact that high-quality primary care was associated with good health behaviors in this study suggests that improving quality of primary care by health care reform can make health behaviors more desirable in patients with essential hypertension.
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